Provider Demographics
NPI:1619904794
Name:CARLSON, MARK JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOEL
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1300 ANNE ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601
Mailing Address - Country:US
Mailing Address - Phone:218-751-9746
Mailing Address - Fax:218-333-5228
Practice Address - Street 1:1300 ANNE ST NW
Practice Address - Street 2:SANFORD HEALTH OF NORTHERN MINNESOTA
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601
Practice Address - Country:US
Practice Address - Phone:218-751-9746
Practice Address - Fax:218-333-5228
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN46685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9831341200Medicaid
MN9831341200Medicaid
MNP00328728Medicare PIN
MN080014917Medicare PIN